CCD Program Registration Home / CCD Program Registration CCD Program Registration LinkedInThis field is for validation purposes and should be left unchanged.Please fill out the Registration Form below:Parent/Legal Guardian 1Name(Required) First Last Relationship to Student(Required)MotherFatherStep-MotherStep-FatherGrandmotherGrandfatherOtherEmail(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent/Legal Guardian 2Name(Required) First Last Relationship to Student(Required)MotherFatherStep-MotherStep-FatherGrandmotherGrandfatherOtherEmail(Required) Phone(Required)Is second guardian's address the same as the first?(Required) Yes No Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Additional Emergency Contact InformationIs your family a registered parishoner of Jesus the Good Shepherd Church?(Required)YesNo, but we attend Mass here and would like to registerNo, we attend Mass and are registered elsewhereWhere are you registered?(Required)How many children are you registering?(Required)Please enter a number from 1 to 8.Child 1Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 2Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 3Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 4Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 5Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 6Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 7Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childChild 8Name(Required) First Middle Last Birth Date (mm/dd/yyyy)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)MaleFemaleSchool(Required)Grade(Required)KindergartenPreK41st2nd3rd4th5th6thPrimarily lives with(Required)MotherFatherBothOtherHas your child received the Sacrament of Baptism?(Required)YesNoName of church, city, and state in which the child was baptized(Required)Has your child received First Holy Communion?(Required)YesNoName of church, city, and state in which the child received First Holy Communion(Required)Has your child completed First Reconciliation?(Required)YesNoPlease explain if there are any medical or educational situations that should be brought to our attention (allergies, gifted, special learning style, learning disability, etc.) for this childDisclaimerSocial Media Disclaimer Our Faith Formation program may take photographs and/or videos of students; these photographs and/or videos document learning and activities of the students. Please be advised we will contact you before posting any photographs and/or videos on our website or social media.Social Media Disclaimer I acknowledge the statement below Our Faith Formation program may take photographs and/or videos of students; these photographs and/or videos document learning and activities of the students. Please be advised we will contact you before posting any photographs and/or videos on our website or social media.
